| At present, China has established a basic framework of social insurance system, the main content of the "enterprise worker is basic endowment insurance", "urban workers basic medical insurance", "urban residents basic medical insurance", "unemployment insurance", "industrial injury insurance, maternity insurance", "new rural cooperative medical, the social insurance system coverage has been expanding constantly. From the perspective of the national economy and social development, the social insurance system gradually perfect and main social insurance project basic full coverage, effectively guarantee the smooth progress of the cause of reform and opening up. "The basic medical insurance" as an important part of social insurance system, through the "transference", "from the city to the countryside" of development, has now been achieved the basic medical insurance system of "full coverage". With the continuous improvement of the level of basic medical insurance of rapid development and protection, especially the background of the aging of the population in China is becoming more and more serious, the smooth running of the basic medical insurance system there has been a problem, the balance of revenue and expenditure of basic medical insurance fund has to face serious challenges. At present, China’s "urban workers basic medical insurance", "the new rural cooperative medical" and "urban residents basic medical insurance" (referred to as "health care workers", "new agriculture" and "the residents of health insurance") three basic medical insurance fund operation of the overall situation is good, fund balance amount is larger, but also is facing fund spending grew rapidly and, in some areas have a deficit, and showing a sustained increase in the trend.Under the guidance of "everyone enjoys the basic medical and health service in 2020," "Twelfth Five Year Plan" period, the government health investment increased year by year,2011-2015 cumulative expenditure 4.63 trillion (2015 as the amount of budget), with an average annual growth rate reached 17.1%. The stable operation of the combined with the long-term development of society and economy, and the present stage of China’s basic medical insurance system, the following three aspects absolutely can not be ignored: in recent years, the basic medical insurance fund expenditures grew rapidly, some areas appeared current income offset "phenomenon and the deficit continues to expand; the second is lower the overall level of the fund, fund size smaller, which exacerbated the parts of the income gap; the third is the personal account funds precipitation, more use efficiency is not high. Both from the point of view of the function of the social security system of bearing or from the perspective of the actual operation of the basic medical insurance system, medical insurance fund long-term benign operation has very important theoretical value and practical significance. This paper through the research established the actuarial model of basic medical insurance, and relevant data in parts of the basic medical insurance, for example, for the future of the system the basic medical insurance fund income and expenditure and gap in long-term operation, carried out a detailed calculation, so as to further improve the basic medical insurance system to provide a more rich and detailed empirical evidence and policy recommendations. At the same time, in recent years, our commercial medical insurance and health insurance actuarial research development faster, but including basic medical insurance, social insurance actuarial work progress is relatively slow, on the whole is still in initial stage, especially compared with some developed countries in Europe and America, there is a significantly larger gap. Therefore, this paper on the theoretical foundation of the basic medical insurance system, combined with the international and domestic large numbers of research results and practical experience of the relatively mature, from the actuarial model construction and empirical analysis of research, finally puts forward corresponding enhance the sustainability of medical insurance fund operation policy recommendations.According to proposed the question, the analysis of the problem and the basic train of thought to solve the problem, this paper starts from the research background and literature review, in clear the current China’s basic medical insurance system architecture and facing the main problems based on, and gradually integrate the actuarial model construction, cost and revenue and expenditure forecasts, and sensitivity analysis, launches the analysis and research of the full text. Concretely, this paper is divided into 10 parts:Chapter 1 is the introduction part. An overview of the background and significance of this topic, to domestic and foreign research situation of evaluation and analysis, the last part of this paper is the research ideas, methods and contents, and points out the possible innovation of the article;The second chapter is the basic medical insurance system system in China. This paper introduces the concrete contents of basic medical insurance system, new type rural cooperative medical system, basic medical insurance system for urban residents, etc.;The third chapter is the basic medical insurance actuarial model design. The design ideas of the model, the model uses the symbol and significance is introduced and the actuarial model of urban employee basic medical insurance, new rural cooperative medical actuarial model and urban residents basic medical insurance actuarial model were constructed.The fourth chapter is the actuarial assumption of basic medical insurance. The life table, wage growth rate, fertility rate, hospitalization rate and the average hospitalization expenses, the urban residents expenditure, the new rural cooperative medical expenses, etc., were evaluated.;The fifth chapter is the population and population forecast of the future. Construction of the general population prediction model and the insured population prediction model, to calculate the population in the next 30 years in Dalian Shineisiqu and focuses on the calculation and analysis of the total actual payment population, on-the-job number of actual payment and the actual number of retirees, dependency ratio;The sixth chapter is the statistical analysis of the actuarial model.. This chapter mainly analyzes and compares the existing data, and analyzes the influence of different factors to the expenses by using the factor and the statistical analysis method;The seventh chapter is the basic medical insurance fund revenue and expenditure analysis. Using the previous model, combined with actuarial assumptions and statistical analysis of the relevant data, the basic medical insurance funds in Dalian actuarial calculation and assessment;The eighth chapter is the sensitivity analysis based on the key index. In Chapter 7, based on estimates, respectively, assuming "mortality", "wage growth rate", "admissions", "change the average expense" and "delay retirement and other different factors, estimates the variation of the above-mentioned factors impact on the operation of the system;The ninth chapter is the short-term assessment of the national basic medical insurance fund. Actuarial models based on the set, and to parts of the basic medical insurance data for calculating results of cases, respectively town worker medical insurance, new rural cooperative medical care system and urban residents medical insurance fund, measurement and evaluation;Chapter 10 is the conclusion part, mainly summarizes the typical experience of the operation of the basic medical insurance system in developed countries, and based on the calculation and analysis of the full text, and gives the improvement in the basic medical insurance system and policy suggestions.The main innovation of this paper is two aspects:first, the innovation of the research perspective. According to the long-term fundamental realities of the primary stage of socialism in our country, and basic medical insurance system in the whole social security system undertakes the important role and function, this paper will focus on operation of fund of insurance of primary medical treatment, not only to seize the present stage our country medical security system construction the key, but also directly for medical insurance system operational sustainability, focus on long-term development; the second is the innovation of research methods. This paper not only for medical insurance for urban residents, medical insurance for urban workers and the new rural cooperative three basic medical insurance, constructs the actuarial model and to place the data of medical insurance as an example was calculated, but also for mortality, wage growth rate, fertility rate, hospitalization rate and delay retirement and other key factors, to carry out the sensitivity analysis and fund operation, such as the short-term assessment. The actuarial method and the relevant conclusions can have important reference value for the operation and system reform of medical insurance fund at this stage. At the same time, due to limitation of the academic level of time and data constraints, and the researcher, this paper although constructs the actuarial model and the statistical analysis and calculation, but there are still some areas for further expansion; at the same time, some convenient analysis of actuarial assumptions may also are not consistent with the reality of the situation, which leads to the results to a certain deviation.
|
PDF Full Text Request